Apparatus for use in mouth-to-mouth resuscitation



Nov. 22, 1966 e. BARTLETT, JR

T APPARATUS FOR USE IN MOUTH-TO-MOUTH RESUSCITATION Original Filed Feb. 9, 1962 Fig.3

INVENTOR.

Roscoe G. Bur eh, Jr

United States Patent 3,286,710 APPARATUS FOR USE iN MOUTH-TO-MOUTH RESUSCITATION Roscoe G. Bartlett, .liu, Lime Kiln, Md.

Original application Feb. 9, 1962, Ser. No. 172,359, now Patent No. 3,219,030, dated Nov. 23, 1965. Divided and this application duly 23, 1965, Ser. No. 474,529

8 Claims. (Cl. 128-29) The invention described herein may be manufactured and used by or for the Government of the United States of America for governmental purposes without the payment of any royalties thereon or therefor.

The present application is a divisional application of applicants copending application, Serial No. 172,359, filed February 9, 1962, for Apparatus for Use in Mouth-to- Mouth Resuscitation .and now US. Patent 3,219,030.

The present invention relates generally to apparatus for aiding victims of respiratory failure .and, more particularly, to apparatus for emergency use in the so-called mouth-to-mout resuscitation method where air is forced directly into the patients lungs in an effort to restore these organs to their normal operation.

In the mouth-to-mouth resuscitation method, the individual endeavoring to assist the party whose respiratory system has been temporarily disabled may be required to establish physical contact between his mouth and that of the patient. Because of this intimacy, there is an understandable reluctance on the part of some people who otherwise are in a position to render help to such victims to participate in this form of first aid. Moreover, during the resuscitation attempt, fluids may discharge from the mouth of the victim and further repel the inexperienced operator, causing him to interrupt or discontinue his efforts. Besides these unpleasant features, the close physical contact required by this technique may be harmful to the operator should the patient be suffering from a communicable disease.

It is therefore a primary object of the present invention to provide apparatus for use in mouth-to-mouth resuscitation wherein physical contact between the parties is avoided.

A still further object of the present invention is to provide resuscitation apparatus for use in the so-called mouth-to-month method wherein the operator is protected from contamination by the patients expired breath.

Another object of the present invention is to provide apparatus for use in mouth-to-mouth artificial respiration wherein the operators and the victims respiratory systems are isolated except during the times the operator is exhaling into the victims lungs.

A yet still further object of the present invention is to provide apparatus for use in mouth-to-mouth resuscitation wherein there is no interference between the operators normal breathing cycle and that of the patient.

A still further object of the present invention is to provide apparatus for use in artificial respiration which provides positive ventilation of the victim.

A yet still further object of the present invention is to provide a simple and inexpensive device for positive artificial ventilation of a victim of respiratory failure wherein the operator need not remove his mouth from the device during the treatment.

Other objects and many of the attendant advantages of this invention will be readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings wherein:

FIG. 1 shows an in-line, piston-type resuscitation device constructed according to One form of the present invention;

FIG. 2 shows one form of a simple, non-loaded check valve assembly for use in the apparatus of FIG. 1; and

"ice

FIG. 3 shows an in-line, bellows-type of resuscitation apparatus.

Referring now to FIG. 1 of the drawings which illustrates in simplified form an in-line piston-type resuscitation device constructed according to one embodiment of the present invention, the operators and patients mouthpiece sections 47 and 48, respectively, are tubular pieces in coaxial alignment with their inner ends coupled to a hollow, cylindrical section 49 of increased diameter. Accommodated within the latter section is a piston 50 which is biased to approximately the position shown by helical spring 51. One end of this spring abuts an inner rim surface 52 of the top wall of section 49, which wall also has formed therein a central aperture 53. The other end of this spring fits within the head of piston 50 and abuts the inner wall surface thereof.

A check valve 54 is mounted in the center of the piston head and opens only during the operators exhalation. This valve which is of conventional design, as best shown in FIG. 2, includes a circular frame 7 having an outer ring 8 and an inner ring 9 concentrically sup-ported therein by a group of radial spokes 10. This frame, it will be appreciated, is mounted in the location shown by any suitable means. Cooperating with this member is a flexible, crescent-shaped diaphragm 11 which has a central ball projection 1-2 extending from one side thereof. This ball, as is well known, can be forced through the central aperture 13 in inner ring 9 from either side thereof to form a complete check valve assembly. It would be noted at this time that this type valve opens only when the pressure acting on side 14 of diaphragm 11 exceeds that on the other side of this member. Thus, in the apparatus of FIG. 1, check valve 58, which is normally closed by the shape and resiliency of its diaphragm, opens only when the pressure on the top side thereof exceeds that on the bottom side, a condition which, it will be seen, occurs only during the exhalation part of the operators breathing cycle when airis being transferred to the patient during the rescue attempt.

A central aperture 55 is also formed in the bottom end wall of section 49, thus completing an air passageway between the operator and the victim. It would be noted at this time that the diameter of piston 50 is made larger than either aperture '55 or the patients mouth piece section 48. This selection of dimensions limits the downward travel of the piston. Cylindrical section 49 is vented to the atmosphere by apertures 56 and 57 formed in the side wall near the lower end thereof.

The operators mouthpiece section 47 has a check valve 58 mounted in its wall portion thereof, and this valve, whose construction is similar to valve 54, opens only during the inhalation effort of the operator to allow him to satisfy his breathing requirements.

The operation of the above-described apparatus is essentially as follows: After appropriate safeguards have been taken to insure the existence of an unobstructed passageway into the patients lungs, the free end of mouthpiece section 48 is inserted into the patients mouth and his nostrils pinched tight. The operator then places his month over his mouthpiece section 47 and commences to breathe deeply at, perhaps, a slightly accelerated rate.

During the inhalation part of his breathing cycle, he draws air into his respiratory system through valve 58 and, while doing so, he is protected from any contamination by piston 50 and the closed condition of check valve 54 mounted in its head portion. When the rescuer exhales, his discharge passes directly down mouthpiece 47, through aperture 53, into section 49, and then through check valve 54 which opens under the force of this discharge, and aperture 55 into the patients mouthpiece section 48 and his respiratory system. During this transfer period the pressure buildup within cylinder 49 forces piston 50 downward to the limit of its travel so that it comes to rest against the inner surface of the lower end wall of this section, still blocking the exhaust ports 56 and 57. Since these ports remain closed, all of the operators exhalation passes directly into the patients system.

At the completion of this exhalation, the elastic recoil of the patients chest and lungs acts to discharge the air thus transferred out of his system. This discharge from the patient, when it takes place, maintains check valve 54 closed and aids in the displacement of piston 50 upwardly against the action of coil spring 531. While this discharge is taking place from the victim, the operator prepares for the next air transfer by taking his next breath, the air for this breath entering through check valve 58. Consequently, a negative pressure is available within section 49 for displacing piston 50 upwardly away from its seat to open exhaust ports 56 and 57 for the victims discharge. This cooperation between the patients discharge and the operators inhalation insures the proper venting of the apparatus and the establishment of an expiratory airway for the patient. There is, therefore, no conflict or interference between the breathing action of the patient when established and that of the operator, no possibility of mutual contamination and no need for the operator to remove his mouth from his own mouthpiece section to satisfy his own breathing demands. The paths over which the intake air, the transferred air and the exhaust air travel are identified in this figure by dashed arrows 6t), 61 and 62, respectively.

It would be mentioned in connection with this modification that if a loaded valve is employed as expiratory valve 54, coil spring 51 may be removed from behind piston 50, and this is particularly so if the apparatus is used in a vertical position. If a spring is used to hold piston 50 slightly against its seat, a loaded valve is not necessary. However, for increased versatility a light spring and an unloaded, simple, flap-type valve is recommended.

Since the operators inspiratory effort exerts a negative pressure directly on the back of the piston rather than through a sensing tube, as is the case in other types of apparatus, the piston in the present case is widely moved during this portion of the operators breathing cycle. Consequently, with a light spring, a low resistance expiratory path is provided for the patient or victim.

It would also be pointed out that the size of piston 50 should be chosen such that it can freely travel within section 4). This fit can be fairly loose so as to minimize the force needed to insure its proper displacement during each breathing cycle. However, it should not be so loose as to allow an appreciable portion of the discharge to leak out around it and pass out through ports 56 and 57 into the atmosphere.

FIG. 3 shows an in-line bellows-type device whose performance is similar to the apparatus shown in FIG. 1. However, in this modification the enlarged cylindrical section 64 houses a bellows 65 closed at its lower end by a check valve 66 of the type hereinbefore described. This bellows and check valve cooperate to control the transfer of air between the operator and the victim and the venting of the latters exhalations in the appropriate part of the cycle. Here, the upper end of bellows 65 is secured or rests against the inner rim surface of the upper end wall 67 of section 64. The lower end of this bellows, as just mentioned, is effectively closed by diaphragm 68 of valve 66. This valve, it will be appreciated, is mounted so as to open only during the exhalation effort of the operator. Normally, the lower end portion 69 of bellows 65 contacts the boundary edge 70 of aperture 71 formed in the lower end wall 72 of section 64. During the operators exhalation effort, this contact is strengthened so that little, if any, of the air expelled reaches exhaust ports 73 and 74. It will be appreciated that FIG. 3 illustrates that time in the cycle during which the victims exhalation is being vented to the atmosphere. In this modification the operators mouthpiece section 75 is again fitted with intake check valve 76.

Since the operation of the apparatus of FIG. 3 is believed obvious in view of what has already been mentioned in connection with FIG. 1, no further explanation of its performance will be given at this point. However, it Would be mentioned that the paths over which the intake air, the transfer air and the exhaust air travel are shown by dashed arrows 77, 78 and 79, respectively.

In connection with the modification of FIG. 3, valve 66 here, too, may or may not be loaded. If this valve is not loaded, then, as shown in this figure, bellows 65 should be constructed so that in its normal position its end rests lightly against its seat. It a loaded valve is used, this bellows may float. The pressure required to seat the bellows in the latter case, however, should be less than the opening pressure of valve 66 so that this seating will take place before valve 66 opens.

The design of the in-line devices of FIGURES 1 and 3 can be somewhat simplified by having the diameter of cylindrical sections 4% and 54 conform to that of the operators and patients mouthpiece section. In other words, all of the apparatus can be incorporated within a single length of cylindrical tubing. To provide the necessary retaining means for the upper end of the coil spring, the open end of the bellows and the valve seats for the piston and the closed end of the bellows, suitable internal collars can be formed in this tubing at appropriate locations. Also, in these in-line devices, the harder :the operator expires the tighter the piston :or bellows presses against its seat. Thus, there is little possibility of air leaking to the outside during the air transfer process.

The diameters of the various airways of the apparatus preferably should be about five-eighths of an inch. Paissageways of this size have negligible resistance, and a very small and compact system can be constructed. As mentioned hereinbefore, the piston in FIG. 1 may be loosely fitted within its cylindrical section. This reduces the friction of the system and at the same time lowers the cost of producing the device.

A simple, fiaplike check valve can be substituted for each of the molded valves 58 and 76 without impairing the operation of the respective embodiments of the invent-ion. Conversely, a molded valve can be substituted for these nonloaded check valves.

While the various modifications hereinbeiore discussed have been described in connection with the so-called rnouth-to-mouth resuscitation method, it will be appreciated that these devices can be used to sustain paralytic polio cases, for example, or patients requiring tracheotomy tube ventilation. In such applications the operator can be replaced with an automatic device having the proper intake and discharge cycle. These resuscitation devices can also be used vvtih pressure-compensated aviation oxygen masks, or other masks, to ventilate the patient with either air or oxygen, depending upon which mode is most advantageous. Either or both the rescuers and patients end of the device may be fitted with a mask. Also, the small percentage Olf carbon dioxide present in the operato-fls expired breath is usually not objectionable and may be beneficial under some circumstances.

Obviously many modifications and variations of the present invention are possible in the light of the above teachings. It is therefore to be understood that within the scope of the appended claims the invention may be practiced otherwise than as specifically described.

What is claimed is:

1. Apparatus for use in mouth t'o-nio-uth resuscitation comprising, in combination,

a tubular member, the open end terminal portions of said member serving as an operators and a patients mouthpiece;

said tubular member having venting ports cut through the wall thereof at a location adjacent the pa-tients mouthpiece;

a first check valve mounted in a wall portion of said tubular member at a ocation adjacent the operators mouthpiece,

said check valve being normally closed and opening only when the pressure at the operators mouthpiece is less than the ambient pressure whereby may be drawn into the interior of said tubular member through said check valve during the inspirational ctiort of the operator to help satisfy his respiratory requirements;

a piston having a head and a cylindrical body portion slidably accommodated within a section of said tubular member with said head portion 'facing said patients mouthpiece;

a second check valve,

said second check valve being mounted in the head of said piston and opening an air passageway from one end to the other of said tubular member when the pressure at the operators mouthpiece is greater than the pressure at the patients mouthpiece whereby the operators exhalations can pass through said second check valve into the patients respiratory system and the patients exhalations cannot pass through said second check valve into the operators respiratory system;

and means normally holding said piston at a first location within said section of said tubular member at which position part of its cylindrical body portion covers said venting ports,

said last-mentioned means permitting said piston to be displaced from .said first position towards the operators mouthpiece whenever the pressure at the operators mouthpiece is less than the pressure at the patients mouthpiece whereby during the inhalation efiort ot the operator said piston moves towards said operators mouthpiece and its cylindrical body portion uncovers said venting ports so that any air expelled into the patients mouthpiece during this inhalation effort may pass out through said venting ports into the atmosphere.

2. In an arrangement as defined in claim 1 wherein said last mentioned means comprises a coil spring having one end abutting said piston and the other end abutting an inner portion of said tubular member.

3. In an arrangement as defined in claim 1 wherein said tubular member has a reduced diameter at a point between the position of said piston head when said piston is at said first location and that end of the tubular member that serves as the patients mouthpiece, which reduced diameter is less than the diameter of said piston whereby, whenever air is discharged into the operators mouthpiece during the operators exhalation efiort, said piston moves towards the patients mouthpiece until it reaches the reduced diameter point, whereupon the pressure at said operators mouthpiece increases and then said second check valve opens.

4. In an arrangement as defined in claim 3 wherein said piston fits loosely within said section of said tubular member so that there is an air passageway from said palients mouthpiece, around the head of said piston, along a part of said cylindrical body portion, and out through said venting ports when said piston is normally held at said first location; and wherein said air passageway is blocked when said piston reaches the reduced diameter point of said tubular member.

5. Apparatus tor use in mouth-to-mouth resuscitation comprising, in combination,

a tubular member, the open end terminal portions of said member serving as an operators and a patients mouthpiece;

said tubular member having venting ports cut through the wall thereof at a location adjacent the patients mouthpiece;

a first check valve mounted in a wall portion of said tubular member at a location adjacent the operators mouthpiece;

said check valve being normally closed and opening only when the pressure at the operators mouthpiece is less than the ambient pressure whereby air may be drawn into the interior of said tubular member through said check valve during the inspirational client of the operator to satisfy his respiratory requirements;

a flexible, cylindrical bellows,

one end oi said bellows being to a circumferential inner wall portion of said tubular memher at a location between said first check valve and said venting ports,

said bellows having a length such that the other end thereof normally extends to a point which is beyond said venting ports;

a second check valve,

said second check valve being secured to said other end of said bellows and normally closing off that end of said bellows,

said second check valve opening an air passageway from one end to the other end of said tubular member only when the pressure at the operators mouthpiece is greater than the pressure at the patients mouthpiece whereby the operators exhalations can pass through said bellows and said second check valve into the patients respiratory system while the patients exhalations cannot pass through said second check valve and said bellows into the operators respiratory system.

6. In an arrangement as defined in claim 5 wherein said bellows is normally in an expanded condition and moves to a contracted condition when the pressure at the operators mouthpiece is less than that at the patients mouthpiece whereby during the inhalation efiort of the operator said other end of said bellows does not extend beyond the location of said venting ports so that any air discharged by the patient during this inhalation elfort can pass out through these ports into the atmosphere.

7. In an arrangement as defined in claim 6 wherein an air passageway normally exists from the patients mouthpiece around said other end of said bellows and through said venting ports into the atmosphere and wherein said air passageway is increased in size during the inhalation effort of the operator when the pressure of the operators mouthpiece drops below the pressure at the patients mouthpiece and said bellows moves to a contracted condition.

8. In an arrangement as defined in claim 5 wherein a seal is formed at a location between said venting ports and that end of the tubular member that serves as said patients mouthpiece by a circumferential portion of said bellows and an inner wall portion of said tubular member whenever the pressure at the openators mouthpiece is higher than that at the patients mouthpiece whereby, whenever said operator exhales, the air which through said bellows and said check valve cannot pass out through said venting ports into the atmosphere.

References Cited by the Examiner UNITED STATES PATENTS 3,090,380 5/ 1963 Dold 138-29 3,124,124 3/ 1964- Cross 128-29 3,158,152 11/1964 Bloom 12829 FOREIGN PATENTS 875,790 8/1961 Great Britain.

RICHARD A. GAUDET, Primary Examiner.- C. F. ROSENBAUM, Assistant Examiner. 

1. APPARATUS FOR USE IN MOUTH-TO-MOUTH RESUSCITATION COMPRISING, IN COMBINATION, A TUBULAR MEMBER, THE OPEN END TERMINAL PORTIONS OF SAID MEMBER SERVING AS AN OPERATOR''S AND A PATIENT''S MOUTHPIECE; SAID TUBULAR MEMBER HAVING VENTING PORTS CUT THROUGH THE WALL THEREOF AT A LOCATION ADJACENT THE PATIENT''S MOUTHPIECE; A FIRST CHECK VALVE MOUNTED IN A WALL PORTION OF SAID TUBULAR MEMBER AT A LOCATION ADJACENT THE OPERATOR''S MOUTHPIECE, SAID CHECK VALVE BEING NORMALLY CLOSED AND OPENING ONLY WHEN THE PRESSURE AT THE OPERATOR''S MOUTHPIECE IS LESS THAN THE AMBIENT PRESSURE WHEREBY AIR MAY BE DRAWN INTO THE INTERIOR OF SAID TUBULAR MEMBER THROUGH SAID CHECK VALVE DURING THE INSPIRATIONAL EFFORT OF THE OPERATOR TO HELP SATISFY HIS RESPIRATORY REQUIREMENTS; A PISTON HAVING A HEAD AND A CYLINDRICAL BODY PORTION SLIDABLY ACCOMMODATED WITHIN A SECTION OF SAID TUBULAR MEMBER WITH SAID HEAD PORTION FACING SAID PATIENT''S MOUTHPIECE; A SECOND CHECK VALVE, SAID SECOND CHECK VALVE BEING MOUNTED IN THE HEAD OF SAID PISTON AND OPENING AN AIR PASSAGEWAY FROM ONE END TO THE OTHER OF SAID TUBULAR MEMBER WHEN THE PRESSURE AT THE OPERATOR''S MOUTHPIECE IS GREATER THAN THE PRESSURE AT THE PATIENT''S MOUTHPIECE WHEREBY THE OPERATOR''S EXHALATIONS CAN PASS THROUGH SAID SECOND CHECK VALVE INTO THE PATIENT''S RESPIRATORY SYSTEM AND THE PATIENT''S EXHALATIONS CANNOT PASS THROUGH SAID SECOND CHECK VALVE INTO THE OPERATOR''S RESPIRATORY SYSTEM; AND MEANS NORMALLY HOLDING SAID PISTON AT A FIRST LOCATION WITHIN SAID SECTION OF SAID TUBULAR MEMBER AT WHICH POSITION PART OF ITS CYLINDRICAL BODY PORTION COVERS SAID VENTING PORTS, SAID LAST-MENTIONED MEANS PERMITTING SAID PISTON TO BE DISPLACED FROM SAID FIRST POSITION TOWARDS THE OPERATOR''S MOUTHPIECE WHENEVER THE PRESSURE AT THE OPERATOR''S MOUTHPIECE IS LESS THAN THE PRESSURE AT THE PATIENT''S MOUTHPIECE WHEREBY DURING THE INHALATION EFFORT OF THE OPERATOR SAID PISTON MOVES TOWARDS SAID OPERATOR''S MOUTHPIECE AND ITS CYLINDRICAL BODY PORTION UNCOVERS SAID VENTING PORTS SO THAT ANY AIR EXPELLED INTO THE PATIENT''S MOUTHPIECE DURING THIS INHALATION EFFORT MAY PASS OUT THROUGH SAID VENTING PORTS INTO THE ATMOSPHERE. 